Aim
The COVID‐19 pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) has put health care workers at risk when exposed to aerosolized viral particles during upper ...airway mucosal surgery. The objective of this review was to discuss topical preparations that could be utilized preoperatively to help to decrease viral load and potentially reduce the risks of viral transmission.
Methods
A PubMed/MEDLINE database review of articles was performed querying topical preparations with virucidal activity against coronaviruses.
Results
Povidone‐iodine (PVP‐I) solutions ranging from 0.23% to 7% have been found to demonstrate highly effective virucidal activity against a broad range of viruses including several coronaviruses responsible for recent epidemics including SARS‐CoV‐1 and MERS‐CoV.
Conclusions
While specific evidence regarding SARS‐CoV‐2 is lacking, PVP‐I‐based preparations have been successfully demonstrated to reduce viral loads of coronaviruses. They are relatively safe to use in the upper airway and may reduce risk of SARS‐CoV‐2 aerosolization during upper airway mucosal surgery.
Background
Recent declines in cancer incidence and mortality have not been distributed equally across the United States. Factors such as tobacco cessation and human papillomavirus presence might ...differentially affect urban and rural portions of the country.
Methods
We used the Surveillance, Epidemiology, and End Results database to assess cancer incidence rates and trends from 1973 to 2015. We compared incidence rates for oral cavity, oropharynx, and larynx cancer in urban and rural counties and identified trends using Joinpoint software.
Results
Incidence of larynx and oral cavity cancer are decreasing faster in urban areas than in rural areas, while incidence of oropharynx cancer is increasing faster in rural areas than urban areas.
Conclusions
Relative trends in incidence of larynx, oral cavity, and oropharynx cancer over the past 40 years are unfavorable for rural United States counties compared with urban areas. Cancer control programs should take this into account.
There is controversy surrounding surgical margins in oral cavity squamous cell carcinoma (OCSCC), with debate regarding the assessment and prognostic value of margins.
To analyze a large cohort of ...OCSCC cases for correlation between tumor specimen margins and intraoperative tumor bed frozen margins and evaluate how margin status associates with local recurrence and survival.
Retrospective cohort study of 406 patients treated with OCSCC resection between 2005 and 2014 at the University of Iowa Hospitals and Clinics. Included cases underwent margin evaluation on the tumor specimen and intraoperative frozen margin assessment from the tumor bed.
Findings of intraoperative frozen margin analysis as a test of tumor specimen margins; local recurrence and survival based on margin findings; prognosis based on clearance of positive frozen margins. To evaluate whether additional resection to "clear" positive frozen margins affected prognosis, we compared local recurrence rates for patients in 3 groups: group A included those patients with negative margins on both intraoperative and permanent specimens; group B included those with positive intraoperative margins subsequently cleared by additional resection to negative margins; and group C included those with negative intraoperative but positive permanent specimen margins.
The median age of the 406 patients (234 men and 172 women) was 61 years (interquartile range, 53-72 years). When frozen margins were correlated with tumor specimen margins, frozen margin accuracy was 65%, with a 46% false-negative rate. We observed a local recurrence rate of 36% (95% CI, 24%-49%) when invasive carcinoma was present at an intraoperative frozen margin and 45% (95% CI, 34%-57%) when invasive carcinoma was found on the permanent specimen margin compared with 19% (95% CI, 14%-26%) and 13% (95% CI, 7%-22%) for completely negative frozen and permanent margin findings, respectively. There was a significant difference in local recurrence between group A (13%) and group B (27%) (absolute difference, 14%; 95% CI, 3%-26%) and between group A and group C (34%) (absolute difference, 21%; 95% CI, 8%-34%), but there was no difference between groups B and C (absolute difference, 7%; 95% CI, -8% to 22%), suggesting that additional resection to clear positive frozen margins does not improve prognosis.
Intraoperative frozen margins from the tumor bed are not ideal predictors of positive margins on the main specimen. Both frozen and specimen margins are associated with local recurrence, but the specimen margin has the stronger association. Importantly, we demonstrate that clearing positive frozen margins from the tumor bed is not associated with improved outcomes.
Objective To conduct a multivariate analysis of a large cohort of oral cavity squamous cell carcinoma (OCSCC) cases for independent predictors of local recurrence (LR) and overall survival (OS), with ...emphasis on the relationship between (1) prognosis and (2) main specimen permanent margins and intraoperative tumor bed frozen margins. Study Design Retrospective cohort study. Setting Tertiary academic head and neck cancer program. Subjects and Methods This study included 426 patients treated with OCSCC resection between 2005 and 2014 at University of Iowa Hospitals and Clinics. Patients underwent excision of OCSCC with intraoperative tumor bed frozen margin sampling and main specimen permanent margin assessment. Multivariate analysis of the data set to predict LR and OS was performed. Results Independent predictors of LR included nodal involvement, histologic grade, and main specimen permanent margin status. Specifically, the presence of a positive margin (odds ratio, 6.21; 95% CI, 3.3-11.9) or <1-mm/carcinoma in situ margin (odds ratio, 2.41; 95% CI, 1.19-4.87) on the main specimen was an independent predictor of LR, whereas intraoperative tumor bed margins were not predictive of LR on multivariate analysis. Similarly, independent predictors of OS on multivariate analysis included nodal involvement, extracapsular extension, and a positive main specimen margin. Tumor bed margins did not independently predict OS. Conclusion The main specimen margin is a strong independent predictor of LR and OS on multivariate analysis. Intraoperative tumor bed frozen margins do not independently predict prognosis. We conclude that emphasis should be placed on evaluating the main specimen margins when estimating prognosis after OCSCC resection.
YouTube has become the preferred resource for trainees in otolaryngology to prepare for surgery. This study aimed to compare the evaluation by 2 attending physicians and 2 resident physicians of the ...quality of videos on YouTube on neck dissection, a key indicator case in head and neck surgery. The authors aimed to assess the quality and quantity of YouTube videos available for development of a virtual surgical educational curriculum for trainees in otolaryngology.
Using the YouTube search feature, the top 10 videos by relevance and view count were compiled using the following search terms: radical neck dissection, selective neck dissection, modified radical neck dissection, lateral neck dissection, levels I-III neck dissection, levels II-IV, left neck dissection, right neck dissection, cervical nodal dissection, and supraomohyoid neck dissection. A total of 37 videos on neck dissection were identified and analyzed using the LAP-VEGaS criteria as well as author-specific modified LAP-VEGaS criteria.
The mean comprehensive LAP-VEGaS score was 8.74 (SD 3.10). The majority of videos (24/37) were designated as medium quality; 10 of 37 videos were low quality and 3 of 37 videos were high quality. In the total group analysis, there was excellent inter-rater reliability between attending physicians (Cohen's kappa coefficient of 0.84) and good inter-rater reliability between resident physicians (Cohen's kappa coefficient of 0.58). There was no correlation between total view count, video age, or number of likes/dislikes and the overall LAP-VEGaS score. The presence of audio or written commentary had a moderate positive correlation with LAP-VEGaS score (adjusted R2 of 0.36). There was no statistically significant difference in video quality between videos posted by US and non-US based physicians (95% confidence interval −0.10 to 4.10; p = 0.06). However, videos made by an otolaryngology-trained physician had a LAP-VEGaS score that was 3.93 points higher (95% confidence interval 2.34-5.52; p < 0.001) than that of videos made by a nonotolaryngology-trained physician.
Online videos of neck dissection represent an increasingly ubiquitous and appropriate resource for trainees in learning otolaryngology key indicator cases. While free-to-access video repositories, such as YouTube, have become increasingly popular among trainees as a primary resource for learning and preparing for surgical cases, they lack consistent quality and as such, global efforts should be taken to improve the breadth and depth of educational video content in otolaryngology.
•Many oral cavity cancer patients present with sarcopenia.•Pre-treatment sarcopenia is associated with significantly worse outcomes.•Radiographic sarcopenia may be a convenient tool in oral cancer ...prognostication.
We performed a systematic review of the literature and meta-analysis to determine how radiographic sarcopenia assessment methods and the presence of pre-treatment sarcopenia impact oncologic outcomes in patients with oral cavity cancer.
Pre-treatment sarcopenia has been associated with poor outcomes in many different malignancies, including head and neck cancers. However, the impact sarcopenia has on outcomes for oral cavity cancer patients is not well understood.
Twelve studies met our inclusion criteria, totaling 1007 patients. 359 (36%) of these patients were reported as sarcopenic. The most commonly utilized sarcopenia assessment methods were L3 skeletal muscle index (n = 5) and C3 skeletal muscle index to estimate L3 skeletal muscle index (n = 5). The majority of studies established their sarcopenia cutoffs as the lowest quartile skeletal muscle index in their patient cohorts. Five studies were included in our meta-analysis, totaling 251 sarcopenic and 537 non-sarcopenic patients. Compared to non-sarcopenic patients, sarcopenic patients were found to have significantly poorer overall survival (univariate: HR = 2.24, 95% CI: 1.71–2.93, I2 = 0%; multivariate: HR = 1.93, 95% CI: 1.47–2.52, I2 = 0%) and disease-free survival (univariate: HR = 2.10, 95% CI: 1.50–2.92, I2 = 0%; multivariate: HR = 1.79, 95% CI: 1.29–2.47, I2 = 10%).
Over one-third of oral cavity cancer patients may present with sarcopenia. Pre-treatment sarcopenia is associated with significantly worse overall and disease-free survival.
Objectives
Oropharyngeal squamous cell carcinoma (OPSCC) has been rising. This manuscript looks to explore racial disparities in the surgical management of OPSCC.
Methods
A cancer database was ...queried for patients with OPSCC diagnosed from 2004 to 2017. Univariate and multivariable logistic regressions were used to evaluate associations between patient race/ethnicity, surgical treatment, and reasons for lack of surgery.
Results
37 306 (74.3%) patients did not undergo surgery, while 12 901 (25.7%) patients did. Non‐Hispanic black (NHB) patients were less likely to undergo surgery than other races (17.9% vs. 26.5%; p < 0.0001). In clinical discussions, the Asian, Native American, Hawaiian, Pacific Islander (ANAHPI), and unknown race group was more likely to directly refuse surgery when recommended (2.5% vs. 1.5%; p = 0.015).
Conclusion
Racial differences exist in treatment for OPSCC. NHB patients are less likely to actually undergo surgical management for OPSCC, while other patients are more likely to directly “refuse” surgery outright when offered.
Vagal neuropathy causing vocal fold palsy is an uncommon complication of vagal nerve stimulator (VNS) placement. It may be associated with intraoperative nerve injury or with device stimulation. Here ...we present the first case of delayed, compressive vagal neuropathy associated with VNS coil placement which presented with progressive hoarseness and vocal cord paralysis. Coil removal and vagal neurolysis was performed to relieve the compression. Larger 3 mm VNS coils were placed for continuation of therapy. Coils with a larger inner diameter should be employed where possible to prevent this complication. The frequency of VNS-associated vagal nerve compression may warrant further investigation.
•Commercial multi-cancer early detection (MCED) tests can detect head and neck cancers.•False-positive MCED tests are possible.•MCED cancer tissue of origin indicators may not be accurate.•Guidelines ...for positive head and neck MCED tests are needed.
Blood-based multi-cancer early detection (MCED) tests are now commercially available. However, there are currently no consensus guidelines available for head and neck cancer (HNC) providers to direct work up or surveillance for patients with a positive MCED test. We seek to describe cases of patients with positive MCED tests suggesting HNC and provide insights for their evaluation.
Retrospective chart review of patients referred to Otolaryngology with an MCED result suggesting HNC. Patients enrolled in prospective MCED clinical trials were excluded. Cancer diagnoses were confirmed via frozen-section pathology.
Five patients were included (mean age: 69.2 years, range 50–87; 4 male) with MCED-identified-high-risk for HNC or lymphoma. Only patient was symptomatic. After physical exam and follow-up head and neck imaging, circulating tumor HPV DNA testing, two patients were diagnosed with p16 + oropharyngeal squamous cell carcinomas and underwent appropriate therapy. A third patient had no evidence of head and neck cancer but was diagnosed with sarcoma of the thigh. The remaining two patients had no evidence of malignancy after in-depth workup.
In this retrospective study, 2 of 5 patients referred to Otolaryngology with a positive MCED result were diagnosed with HPV + oropharyngeal squamous cell carcinoma. We recommend that positive HNC MCED work up include thorough head and neck examination with flexible laryngoscopy and focused CT or MRI imaging. Given the potential for inaccurate MCED tissue of origin classification, PET/CT may be useful in specific situations. For a patient with no cancer identified, development of clear guidelines is warranted.
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